Transplant Renal Artery Stenosis in 77 Patients-Does It Have an Immunological Cause?1

Abstract

Transplant renal artery stenosis (TRAS) is a common complication after transplantation and is an important cause of graft dysfunction. Damage from graft rejection, trauma, and atherosclerosis have been implicated as possible causes. We reviewed all 917 patients transplanted in our unit since 1978 to study the prevalence, clinical features, and possible causes of TRAS. Seventy-seven patients with TRAS were identified. The detected incidence was 2.4% before the introduction of color doppler ultrasonography (CDU) and rose to 12.4% after CDU was introduced in 1985, giving an overall incidence of 8.4% during a mean follow-up period of 6.9 years. The TRAS group was compared with a control group of 77 transplanted patients matched for age, year of transplant, sex, and number of previous grafts. Mean ages for the study and control groups were 43.6 +/- 15 and 44.8 +/- 13.7 yr. A total of 25% of cases of TRAS were diagnosed within the first 8 wk of transplantation and in 60% within the first 30 wk (median = 23 wk). All patients were treated with angioplasty, 28 patients had recurrence of TRAS requiring multiple angioplasties (maximum 5) and 1 went on to have surgery. Angioplasty resulted in a significant fall in plasma creatinine. Patient and graft survival were significantly worse in the TRAS group: 69% vs. 83% (P < 0.05) and 56% vs. 74% (P < 0.05) (TRAS vs. Control), respectively. There was a significantly higher incidence of rejection, especially cellular rejection in the TRAS group, 0.67 vs. 0.35 episodes per patient (P < 0.01) (TRAS vs. Control). Recurrence but not occurrence of TRAS was associated with the use of cyclosporine.

Surgical Complications After Pediatric Renal Transplant

“…In our study, no patient died because of urologic complications, and we showed considerably good results (urinary leak rate was 2.5%, stenosis rate was 5%) compared with the literature (2.5%-25%). [12][13][14][15] Decreased blood supply to the donor ureter and faulty surgical techniques are the main causes of urologic complications; however, other problems, such as immunosuppressive drugs and rejections, can cause late obstruction. Although low-dose steroid protocols and meticulous operative techniques tend to reduce incidence or urologic complication, 10 poor ureteral vascularization owing to increased use of expanded criteria donors, especially older individuals, tend to increase this rate.…”

Contrast enhanced MR angiography with parallel imaging in the early period after renal transplantation

“…Arterial stenoses after renal transplantation may be located at the anastomotic site due to vessel perfusion injury, faulty suture technique, or reaction to suture material, or distally to the anastomosis due to rejection, turbulent flow from kidney malposition, arterial twisting, kinking, and compression (23)(24)(25)(26). Excessive traction of the graft artery during the harvesting, cannulation for transplant perfusion, or a surgical clamp may cause endothelial injury, intimal tears, and vascular dissection.…”

Transplant Renal Artery Stenosis

“…Wong et al found a significantly higher incidence of ACR in their TRAS group compared to controls (0.67 vs 0.35 episodes per patient) with significantly poorer patient and graft survival [7]. Acute rejection was also found to occur more frequently in patients with TRAS (48%) compared to the non TRAS group (27%), although the difference was insignificant [9].…”